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Clinical Effectiveness and Cost Benefit of Universal versus Targeted Methicillin-Resistant Staphylococcus aureus Screening upon Admission in Hospitals

Published online by Cambridge University Press:  02 January 2015

Kathryn K. Leonhardt ,
Olga Yakusheva ,
David Phelan ,
Anne Reeths ,
Teresa Hosterman ,
Deborah Bonin  and
Mike Costello
Kathryn K. Leonhardt*
Affiliation:
Aurora Health Care, Milwaukee, Wisconsin
Olga Yakusheva
Affiliation:
Marquette University, Milwaukee, Wisconsin
David Phelan
Affiliation:
Aurora Health Care, Sheboygan, Wisconsin
Anne Reeths
Affiliation:
Aurora Health Care, Green Bay, Wisconsin
Teresa Hosterman
Affiliation:
Aurora Health Care, Sheboygan, Wisconsin
Deborah Bonin
Affiliation:
Aurora Health Care, Milwaukee, Wisconsin
Mike Costello
Affiliation:
Aurora Health Care, Milwaukee, Wisconsin
*
Aurora Health Care, 12500 West Bluemound Road, Suite 301, Elm Grove, WI 53122 (Kathy.Leonhardt@aurora.org)
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Abstract

Objective.

To conduct an exploratory study to evaluate the clinical effectiveness and cost benefit of universal versus targeted screening for methicillin-resistant Staphylococcus aureus (MRSA) to prevent hospital-acquired MRSA infections.

Design.

Prospective, interventional study, using a case-control design, difference-in-differences, and cost-benefit analyses.

Setting.

Two community hospitals in Wisconsin.

Patients.

Consecutive sample of 15,049 adult admissions from April 2009 to July 2010.

Interventions.

MRSA surveillance performed by polymerase chain reaction (PCR) on samples collected from all adult patients (aged over 18 years) within 30 days before or upon an admission to the hospital. During a 9-month baseline period, targeted screening was conducted at both hospitals. During the 5-month intervention period, all patients admitted to the intervention hospital were screened for MRSA. Infection control measures were consistent at both hospitals.

Results.

Universal screening was associated with an increase in admission screening of 43.58 percentage points (P<.01), an increase in MRSA detection of 2.95 percentage points (P<.01), and a small, nonsignificant decline in hospital-acquired MRSA infections of 0.12 percentage points (P = .34). The benefit-to-cost ratio was 0.50, indicating that for every dollar spent on universal versus targeted screening, only $0.50 is recovered in avoided costs of hospital-acquired MRSA infection.

Conclusion.

Compared with targeted screening, universal screening increased the rate of detection of MRSA upon hospital admission but did not significantly reduce the rate of hospital-acquired MRSA infection. Universal screening was associated with higher costs of care and was not cost beneficial.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 8 , August 2011 , pp. 797 - 803
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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References

1.Cosgrove, SE, Qi, Y, Kaye, KS, Harbarth, S, Karchmer, AW, Carmeli, Y. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 2005;26:166–174.Google Scholar
2.Peterson, LR, Hacek, DM, Robicsek, A. Case study: an MRSA intervention at Evanston Northwestern Healthcare. Jt Comm J Qual Patient Saf 2007;33(12):732–738.Google Scholar
3.Harbarth, S, Fankhauser, C, Schrenzel, J, et al.Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients. JAMA 2008;299(10):1149–1157.Google Scholar
4.Robicsek, A, Beaumont, JL, Paule, SM, et al.Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Ann Intern Med 2008;148(6):409–418.Google Scholar
5.Peterson, LR, Diekema, DJ. To screen or not to screen for MRSA. J Clin Microbiol 2010;48(3):683–689.Google Scholar
6.Rodriguez-Bano, I, Garcia, L, Ramirez, E, et al.Long-term control of endemic hospital-wide methicillin-resistant Staphylococcus aureus (MRSA): the impact of targeted active surveillance for MRSA in patients and healthcare workers. Infect Control Hosp Epidemiol 2010;31(8):786–795.Google Scholar
7.Tacconelli, E, De Angelis, G, de Waure, C, Cataldo, M, La Torre, G, Cauda, R. Rapid screening tests for methicillin-resistant Staphylococcus aureus at hospital admission: systematic review and meta-analysis. Lancet Infect Dis 2009;9:546–554.Google Scholar
8.McGinigle, K, Gourlay, M, Buchanan, I. The use of active surveillance cultures in adult intensive care units to reduce methicillin-resistant Staphylococcus aureus–related morbidity, mortality, and costs: a systematic review. Clin Infect Dis 2008;46:1717–1725.Google Scholar
9.CDC. The National Healthcare Safety Network (NHSN) Manual, Patient Safety Component. Protocol multidrug-resistant organisms. December 2008. http://www.cdc.gov/ncidod/dhqp/pdf/nhsn/MDRO_CDADprotocolv41Dec08final.pdf. Accessed March 15, 2009.Google Scholar
10.Folland, S, Goodman, AC, Stano, M. The Economics of Health and Health Care. 6th ed. Upper Saddle River, NJ: Pearson Education;2010.Google Scholar
11.Murray, MP. Econometrics: A Modern Introduction. Boston: Pearson Education; 2006.Google Scholar
12.Chaix, C, Durand-Zaleski, I, Alberti, C, Brun-Buisson, C. Control of endemic methicillin-resistant Staphylococcus aureus: a cost-benefit analysis in an intensive care unit. JAMA 1999;282:1745–1751.CrossRefGoogle Scholar
13.Hardy, K, Price, C, Szczepura, A, et al.Reduction in the rate of methicillin-resistant Staphylococcus aureus acquisition in surgical wards by rapid screening for colonization: a prospective, cross-over study. Clin Microbiol Infect 2010;16(4):333–339.Google Scholar
14.Harbarth, S, Masuet-Aumatell, C, Schrenzel, J, et al.Evaluation of rapid screening and pre-emptive contact isolation for detecting and controlling methicillin-resistant Staphylococcus aureus in critical care: an interventional cohort study. Crit Care 2006;10:R25.Google Scholar
15.Jeyaratnam, D, Whitty, CJ, Phillips, K, et al.Impact of rapid screening tests on acquisition of methicillin resistant Staphylococcus aureus: cluster randomised crossover trial. BMJ 2008;336(7650):927–930.Google Scholar
16.Engemann, JJ, Carmeli, Y, Cosgrove, SE, et al.Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 2003;36:592–598.Google Scholar
17.Anderson, DJ, Kaye, KS, Chen, LF, et al.Clinical and financial outcomes due to methicillin resistant Staphylococcus aureus surgical site infection: a multi-center matched outcomes study. PLoS ONE 2009;4(12):e8305.Google Scholar
18.Larcombe, L, Waruk, J, Schellenberg, J, Ormond, M. Rapid emergence of methicillin-resistant Staphylococcus aureus (MRSA) among children and adolescents in northern Manitoba, 2003–2006. Can Commun Dis Rep 2007;33(2):9–14.Google Scholar
19.Kallen, AJ, Mu, Y, Bulens, S, et al.Health care-associated invasive MRSA infections, 2005–2008. JAMA 2010;304(6):641–648.Google Scholar
20.Cohen, AL, Calfee, D, Fridkin, SK, et al.Recommendations for metrics for multidrug-resistant organisms in healthcare settings: SHEA/HICPAC position paper. Infect Control Hosp Epidemiol 2008;29(10):901–913.Google Scholar
21.Huang, SS, Platt, R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis 2003;36:281–285.Google Scholar